Research paper
‘Just gripping my heart and squeezing’: Naming and explaining the emotional experience of receiving bad news in the paediatric oncology setting

https://doi.org/10.1016/j.pec.2017.03.028Get rights and content

Highlights

  • Recipients’ emotional experiences during their bad news consultation were examined.

  • Experiences included bodily sensations, affective states, and cognitive conditions.

  • Experiences related to the news and perceived consequences, more than its delivery.

  • Strong emotional experiences do not necessarily indicate an ineffectual interaction.

Abstract

Objective

To explore recipients’ perspectives on the range and origins of their emotional experiences during their ‘bad news’ consultations.

Methods

Participants were four bereaved families of children who had changed from active treatment to palliative care in paediatric oncology. Data was collected using emotional touchpoint storytelling. The names (descriptors) given to the emotional experiences were linguistically classified. Explanations of their perceived origins were examined using applied thematic analysis.

Results

26 descriptors were given, relating to bodily sensations, affective states, evaluations and cognitive conditions. Three themes were identified in the origins of these experiences – ‘becoming aware’, ‘the changes’ and ‘being in this situation’. Parents described strong emotional displays during the consultation including physical collapse. These related to the internal process of ‘becoming aware’. Three descriptors were given as originating from the clinicians and their delivery of the news – ‘supported’, ‘included’, ‘trusting’.

Conclusions

Recipients perceive their emotional experiences as mainly originating from the news itself, and perceived consequences of it, rather than its delivery. Strong emotional reactions during the interaction are not necessarily an indicator of ineffectual delivery.

Practice Implications

Findings offer a thematic framing that may support and deepen practitioners understanding of recipients’ emotional reactions during bad news consultations.

Introduction

Breaking bad news is perceived by practitioners as one of the more challenging aspects of their work, even by those practitioners who find themselves in this situation on a relatively regular basis [1], [2]. Clinicians may exhibit physiological stress responses before and during the delivery of bad news and experience ongoing anxiety, sometimes for a matter of days, when such interactions are perceived as not having gone well [2], [3], [4]. They particularly struggle with recipients’ emotions and reactions to the news and assume personal responsibility for the emotional outcome [5], [6], [7]. Moreover, practitioners tend to interpret strong emotional reactions by recipients as an indicator of ineffectual communication or a failing on their part [1], [5], [8].

Researching recipients’ perspectives on bad news interactions are difficult [9], [10], [11], [12] and the established literature base has focused mainly on measurement of recipients’ satisfaction with clinicians’ technique, their comprehension of the information given, and the identification of which aspects of time, place and person the recipients liked or disliked [13], [14], [15], [16]. In effect, even when the recipients’ perspectives are sought, it is still the deliverer and the delivery processes that are examined, with only a few notable exceptions [17], [18], [19], [20].

While such research has facilitated significant improvements in the training and management of bad news communication [21], [22], [23] it might be also counterproductive, ignoring the potential individual influences arising from the wider psychosocial contexts of such interactions [24], [25], [26], and perpetuating clinicians’ own potentially damaging or self-critical responses to this aspect of their work.

Studies that have examined the recipients’ perspectives on receiving bad news have identified a broader time-frame in recipients’ understanding of the phenomenon, with receiving bad news viewed as an ongoing process in being seriously ill rather than a single isolated communication [17], [18], [19]. However, within those studies the moments of diagnostic confirmation and communications outlining new prognostic information have still been represented as key aspects of the experience [17], [18], [20] and bad news consultations continue to be viewed as pivotal moments in healthcare relationships [27], [28], [29].

The aim of this study was to gain a better understanding of the emotional experience of receiving bad news, and of recipients’ perspectives on the origins of their emotional reactions experienced during bad news consultations.

Section snippets

Methods

The Local Research Ethics Committee granted ethical approval for the project in September 2012, with agreement from the local NHS research and development office. All participants provided informed written consent. Pseudonyms are used in the reporting of the research to maintain participant anonymity.

Naming the experiences

Each family picked a range of descriptors from available pre-printed cards and chose to write a few of their own labels as well, selecting between five and 13 descriptors each. No single descriptor was chosen by all of the participants. The linguistic categorisation of the selected words is presented in Table 2.

The word ‘sick’, which was used as a descriptor by two different families, can be categorised as both a physical state and an affective state. While an affective state, related to

Discussion

This study explored recipients’ interpretations of their experiences of receiving bad news taking an open, non-directive approach in order to gain insights into recipients’ own beliefs about the origins of their feelings, rather than directing them to consider whether specific aspects, such as the clinician, clinic environment or language used, had played any role.

Of the 26 descriptors chosen in this study, only three were directly connected to the experience of the clinician and the management

Conflicts of interest

None.

Role of funding

This research was supported by The Edinburgh and Lothians’ Health Foundation Fund, with additional financial assistance provided by Children’s Cancer and Leukaemia Endowment Fund. The sponsors had no involvement in the study’s design, the collection, analysis or interpretation of the data, nor in the writing of the study report or decisions about publication.

Acknowledgement

The authors gratefully acknowledge the support of Dr Stephen Smith of the Leadership in Compassionate Care Programme, Edinburgh Napier University, for providing the Emotional Touch Points resources and training.

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